The development of referral guidelines for dentists referring children for extractions under general anaesthesia

Objective To develop a set of guidelines for referral of children for simple extractions under general anaesthesia and to determine if services providing general anaesthetic extractions comply with the guidelines. Design The guidelines were developed with reference to published literature and experts in the field. Patient's records were used to determine the compliance with the guidelines. Setting Community dental services in the North West of England in 2000. Subjects One hundred and ninety six sets of patient records of children attending to have teeth extracted under general anaesthesia were studied. Results The mean age of the 196 children was 6.8 years (SD=2.5 years) and ranged from 2.7 to 15.8 years. Caries was the prime reason for extractions (182; 93%). Of the 196 children who received a general anaesthetic, 103 (53%) dentists had complied with the general anaesthetic referral guidelines whilst 93 (47%) had not. There was wide variation in compliance across 11 trusts in the North West of England. The lowest compliance was 25% and the highest 93%. Conclusion This study has demonstrated that there can be considerable agreement amongst a group of experts on what constitutes clear justification for extracting teeth under general anaesthesia. However there can be marked variation in compliance with these guidelines.